NT-proBNP对室缺并肺炎患儿心脏严重程度的评估效能分析  

The significance of NT-proBNP to evaluate the severity of heart in patients with ventricular septal defect and pneumonia

作　　者：左超[1] 陈智[1] 肖云彬[1] 杨舟[1] 王野峰[1] 王祥[1] 王丹 ZUO Chao;CHEN Zhi;XIAO Yunbin;YANG Zhou;WANG Yefeng;WANG Xiang;WANG Dan(Department of Cardiology,Hunan Children's Hospital,Changsha,410007,China)

机构地区：[1]湖南省儿童医院心血管内科,长沙410007

出　　处：《临床急诊杂志》2020年第2期139-142,共4页Journal of Clinical Emergency

基　　金：湖南省卫生健康委科研计划课题项目(No:B2019014).

摘　　要：目的:探讨N-末端脑钠素原(NT-proBNP)在先天性室间隔缺损合并肺炎患儿心脏严重程度评估的效能。方法:选择2018-01—2018-12期间于我院心血管内科住院的室间隔缺损并肺炎患儿,入院时检测NT-proBNP水平,比较有无肺动脉高压的两组间病人lg(NT-proBNP)差异,不同NT-proBNP水平下诊断肺动脉高压的效能。根据最佳界值,作不同室间隔缺损大小诊断NT-proBNP是否大于该界值的ROC曲线分析,得出室间隔缺损大小诊断NT-proBNP最佳界值的效能,建立室间隔缺损大小与NT-proBNP的联系。结果:有肺动脉高压组其lg(NT-proBNP)水平为3.78±0.40,无肺动脉高压组lg(NT-proBNP)水平为3.07±0.65,两者差异有显著意义;NT-proBNP诊断发生肺动脉高压的抽样工作特征曲线下面积为0.81(0.72,0.90),在临界值为2 000 pg/mL时,诊断发生肺动脉高压的敏感度及特异度分别为96.00%和59.15%;室间隔缺损大小诊断NT-proBNP是否大于2 000 pg/mL的ROC曲线下面积为0.90(0.83,0.97),在室间隔缺损大小为4.0 mm时,诊断NT-proBNP>2 000 pg/mL的敏感度和特异度分别为98.11%和76.74%;室缺大小以4.0 mm为界值分组,NT-proBNP以2 000 pg/mL为界值分组,两组间卡方检验有显著统计学意义(χ~2=58.16,P=0.00)。结论:NT-proBNP水平与室缺并肺炎患儿肺动脉高压严重程度有显著相关性,在NT-proBNP>2 000 pg/mL时,是提示患儿合并肺动脉高压的重要参考,也提示其缺损有较大可能性大于4.0 mm,应引起对此类患儿的重视,进行更密切的随访,必要时早期转诊至有手术条件医疗机构。Objective: To investigate the value of N-terminal pro-B-type natriuretic peptide(NT-proBNP) in evaluating the severity of patients with ventricular septal defect and pneumonia. Method: The patients with ventricular septal defect and pneumonia treated in department of cardiology in Hunan Provincial Children’s Hospital from Jan of 2018 to Dec of 2018 were recruited and the level of serum NT-proBNP was detected on admission. Compare the difference of NT-proBNP between patients with or without pulmonary hypertension. The ROC curve for NT-proBNP to diagnosis pulmonary hypertension was drawn. The best value of NT-proBNP to diagnose pulmonary hypertension was calculated, according to the best value to grouping all of the patient, and the ROC curve for the size of ventricular septal defect to diagnose whether the value of NT-proBNP is higher than 2000 pg/ml. Then connection between the size of ventricular septal defect and value of NT-proBNP was build. Result: The value of lg(NT-proBNP) in patients with pulmonary hypertension was(3.78±0.40), which was higher than those without pulmonary hypertension(3.07±0.65)(P<0.05). The area under ROC for NT-proBNP levels to diagnose pulmonary hypertension was 0.81 with sensitivity 96.00% and specificity 59.15% at a critical value of 2000 pg/ml. The area under ROC for size of ventricular septal defect to diagnose NT-proBNP higher than 2000 pg/mL was 0.90 with sensitivity 98.11% and specificity 76.74% at a critical value of 2000 pg/ml. Patients were distributed by 4 mm of ventricular size and 2 000 pg/mL of NT-proBNP. There were significant differences between these two groups(χ~2=58.16, P=0.00). Conclusion: The level of NT-proBNP is significantly connected with the pulmonary hypertension of the patients with congenital ventricular septal defect and pneumonia. The level of NT-proBNP higher than 2000 pg/ml is a signal of complication with pulmonary hypertension and the ventricular septal defect bigger than 4 mm. Much more attention should be paid for patients with NT-proBNP higher

关 键 词：N-末端脑钠素原 室间隔缺损 儿童 

分 类 号：R725[医药卫生—儿科]